'Something we would see in a war zone:' Military surgeons on the wounds they treated in Las Vegas
By TIM CRAIG | The Washington Post | Published: October 5, 2017
LAS VEGAS — As part of his summer training, Maj. Charles Chesnut, a U.S. Air Force surgeon, practiced assembling mobile medical operations within 10 minutes of landing in a war zone to treat wounds from high-caliber bullets, shrapnel and explosions.
On Sunday night, in an unimaginable test for the 34-year-old doctor, Chesnut's neighbors here in the United States became his patients from the battlefield.
The Las Vegas Strip shooting became the first time that Chesnut used his new training to treat multiple gunshot victims at the same time. Called "Austere Surgical Teams" and finalized by the Air Force in July, the teams are designed to build off the lessons learned by the U.S. military during the wars in Iraq and Afghanistan.
After receiving a telephone alert about Stephen Paddock's rampage on Sunday night, Chesnut jumped into his car and drove to the University Medical Center of Southern Nevada as gunshot victims were streaming into the trauma center.
What followed was one of the most hectic nights of Chesnut's military career, reflecting the warlike carnage that Paddock inflicted on concertgoers at a country music festival.
"These are injuries I never expected to see stateside," said Chesnut, adding that he went through 40 pairs of sterile medical gowns just to treat the crush of patients.
At the hospital, Chesnut was quickly joined by Lt. Col. Jason Compton and two other military surgeons from the Nellis Air Force Base in Las Vegas.
In an interview Wednesday evening, Chesnut and Compton recounted the frenzied scene inside the hospital and how their war-training made a difference.
In all, Paddock killed 58 people and wounded nearly 500 before he took his own life. The University Medical Center treated 104 of those patients. More than 80 percent of them suffered gunshot wounds from high-caliber ammunition.
The rounds struck victims with horrific force, causing severe damage to human tissue and organs.
"These were definitely injuries you would see in a war zone," said Compton, the general surgery flight commander for the 99th Medical Group, who has been deployed to U.S. military hospitals in Qatar twice.
When Chesnut and Compton arrived at the University Medical Center shortly after midnight, the trauma center was packed with patients in urgent need of assessment.
Crude tourniquets had been affixed onto many victims to control bleeding, but quick decisions had to be made to prevent fatal blood loss.
And with hospital resources taxed by the influx of patients, Chesnut and Compton said, their military training proved invaluable in helping to triage patients.
The new Air Force mobile surgical teams - more nimble offshoots of military field hospitals - were redesigned by the Air Force this year so medical decisions can be made faster on the battlefield, according to Col. Virginia Garner, the commander of the 99th Medical Group.
Each team consists of a surgeon, an anesthesiologist, an emergency room physician, a critical-care nurse, a scrub technician and a medical administrator. One team can conduct five sterile, open-air operations.
The team members are trained to react expeditiously under overwhelming circumstances, relying on their medical instincts to decide which patients can be stabilized quickly enough for evacuation to military hospitals.
"We use very little blood, no CT scanners, just ultrasounds, and our clinical diagnostic skills," Chesnut said. "So, when I walked into that trauma resuscitation bay on Sunday night and Monday morning, I thought to myself, 'How would I treat these patients working in the middle of the desert in five-man teams'?"
Initially, Chesnut and Compton saw 20 to 30 patients waiting for evaluation for what appeared to be gunshot wounds to their arms and legs. To move them along the treatment process, the two began helping other doctors to check the victims' pulse rates.
If pulse rates in damaged extremities differ from other parts of the body, that would be a sign that an amputation may be needed.
No amputations ultimately were required, so the surgeons then began assessing for internal injuries. High-caliber weapons can leave deceptively small entrance wounds, Compton said.
"The hospital only had so many CT scanners, and you have a lot of people with extremity injuries . . . so who gets that precious CT scanner first?" said Compton, an 11-year-veteran of the Air Force. "The triage skills that we learned, training to go out on these small surgical teams, where even five or six patients and we can be overwhelmed, all helped us decide who gets that resource first."
As the backlog of patients began to lessen, the Air Force surgeons began helping University Medical Center doctors care for even more critically wounded patients.
Because Paddock had been firing from the 32nd floor of the Mandalay Bay Resort and Casino, many bullets struck victims in the chest before smashing downward into the abdomen. That caused rare, severe wounds to both patients' chests and their abdomens.
"The thing that struck me most, which I did not expect to see, is the trajectory," Chesnut said. "When gunshots enter through the chest and go through the abdomen, you have potentially catastrophic injuries because you can die from an injury to the chest and injury to the abdomen."
Chesnut and Compton also found it unusual that so many patients did not suffer exit wounds, considering the speed of the rounds.
"We found a lot of bullets," Chesnut said. "Whether those bullets passed through another individual and ended up in our patients, it's impossible to say."
The rounds also caused devastating injuries to arteries, Chesnut said. He recalled helping to put a chest tube into one young man.
"I have never seen so much blood pour out of anyone," the officer said. "But we saved his life."
About nine hours after they arrived, Chesnut and Compton left the hospital Monday. Now, they must carry the weight of the experience onto far more familiar grounds.
Chesnut is leaving this weekend to take part in the Air Force's rescue mission in Puerto Rico. Compton also is preparing for deployment, but he can't say where for security reasons.
When they arrive on their missions, both hope they never again see what they saw Sunday night. But if they do, they said, they will be even more prepared.
Early Monday morning, Chesnut recalled having to tell a man who was huddled in the University Medical Center that his wife did not survive a gunshot wound to the head.
"Every surgeon has a graveyard in their mind of the patients that we have lost, and we use what we learned from the patients that we lost to better care for patients in the future," he said.